Jungle Jack Journals
- A True Story About psycho-Paranoia In The Jungle
There once was a fisherman casting his nets under a moon-lit sky. He heard a sound and pulled his little dugout closer to shore to see what it was. It was a group of people, apparently men, who were scantly visible in the heavy jungle growth. The men were talking as they walked along their way.
The fisherman, not knowing who might be walking along that route at this time of night, began to suspect their possible intentions. What were they up to? Did they have guns? Then he heard another sound; A tap or a click of metal. Aaah!, that could have been the sound of a gun clip!
The fisherman quietly made his evasion unnoticed and went to alert someone else. This other person in turn traveled along the shore to alert his buddies at the Iawaska camp that was located in the direction of this suspicious group. When the fellow arrived he whispered a few comments to the first watchman he could find. This watchman told another and soon the entire camp was stirring with commotion. They then sent out two guards with two women across the lake in a dugout canoe to get some help. They landed on my doorstep at 9:30 p.m. and that is how I came to be involved.
For what ever reason, by the time the story hit my doorstep it had a slightly different ring to it than when the fisherman first whispered it to his friend. A heavy pounding on my door alerted me to two frantic middle-aged American women. “We are being attacked by 70 armed men! Can you help us, please?” I knew it was going to be one of those nights.
Well of course we helped them even though we seriously doubted the reality of what they insisted to be imminent death at the hands of a band of jungle guerrillas. We called the police but knew they would be late in arriving and lacking in any desire to chase bad guys. We called the U.S. Embassy who in turn called our friends at the local police branch to light a fire under their less-than-motivated hind quarters. It worked. Before long I was receiving calls from every possible police branch in the Pucallpa area, asking how they might be of assistance. Ironically, I really didn’t want to deal with any police that night. They were the last people I wanted to deal with but I figured it was necessary to appease our friends who were seeking protection in our kitchen. Five minutes ago I was tucked away in bed!
Tom, Craig, and I loaded up into a boat and headed across the lake to save the rest of the group from what we were told was imminent attack. The lake had a surface of black crystal, illuminated by the light of a big blue moon over the jungle; almost romantic except for the fact that we were armed to the teeth and headed out to save the day! And I asked myself, “Self, how did I get here”?
We made a couple shuttles to get everybody across the lake where they were safe and sound. It was while Tom and I were scoping around the camp that we discovered the original fisherman who was the only person who supposedly saw anything. What he told us was that he really didn’t see anybody, but heard a group of people; a group of perhaps ten. I could tell that even ten was stretching it. Having exploited this little bit of information the best I could in the midst of everybody present at the camp, I was surprised to see that it did nothing to lower their fear. They were still convinced that the small army was hiding less then 70 meters away, ready to attack.
Now let me explain to you where I was. I was standing in the middle of the Iawaska camp. The camp attracts drifters, mystics, wanderers, and general riff-raff from the US and Europe. For $500 you can discover the wonderful healing powers of a drug that witch doctors have been using for generations. It is a fairly powerful drug that surpasses the effects of marijuana and causes hallucinations and paranoia. It is legal. But as I walked through the camp, I could also smell the distinct aroma of marijuana. That is illegal. Having heard enough to cry and smelled enough to fly home, we headed back down to the port to catch the last shuttle back to home base.
I got back to my house and found Lisa in the kitchen still hosting our two middle-aged mystics. As I entered I noticed the two ladies were in the middle of some healing ritual where one was casting out the effects of mosquito bites by using the laying on of hands and mind-over-matter. The dialog went something like this:
Doctor: Is there mosquito venom in you?
Patient: Yes.
Doctor: No, you’re suppose to say no.
Patient: Oh, okay. No.
Doctor: You want all effect to leave you now.
Patient: Am I supposed to say yes?
Doctor: yeah.
Patient: Okay, yes.
And on it went. I was just about to introduce our doctor friend to the miracle healing powers of Hydrocortisone cream when the telephone rang. It was the General from the PNP (Peruvian National Police). “Excuse me folks, I’m talking to the General. Could you please keep it down?”
I had met the General on one previous occasion so I could truthfully say we were acquaintances. Six months ago I invited the General and five of his top brass to our house for a little get-to-know-you session. Heck, we were almost on a first name basis!
The Embassy had called him to fill him in as to what they thought was happening out at some place called Cashibococha. I said yes sir, no sir and thank you sir at all the right times and he gave me his home phone number to call anytime I needed. Cool!
I finally crawled back in bed around midnight having delivered our friends out to the highway where they enjoyed a police escort back into town. Lisa and I enjoyed a good laugh at the lunacy of the past three hours.
The Holy Man
Throughout the evening I kept hearing about Don Mateo. Don Mateo is listed as an Elder on his website and is the owner of this little psycho-adventure tourist camp across the lake. The people coming through are genuine searchers looking for fulfillment or healing in their psycho-spiritual lives. One person had cancer while some were just trying to unite with nature. Others simply saw it as a cool way to get high with the natives.
It has been my observation that there are three kinds of people in the world. First, those who have defined their world view very clearly and try to pattern their lives around it. They have principle and purpose by which they make their decisions, and communicate it to others by the way they live their lives. Christians should be included in this group. Secondly, there are those who understand a particular world view from their upbringing or heritage but actively live against the laws and principles that run parallel to it. And finally there are those who have no clue as to what world view they carry and have no interest in finding out. These are the ones that will answer with a profound, “daah, boy I don’t know. That’s a good one.”, if you ask them what their purpose in life is.
I have little patience for the last group which unfortunately is the most rapidly growing group in the Western Culture now days. It’s the ‘what-ever’ crowd. The second group is usually backsliders and rebellious youth rejecting principle solely on the basis that ‘you can’t make me be like you’. I get frustrated with this group. That leads us back to the first group; those that are actively trying to build their lives around a clearly defined set of laws. At least you can engage in meaningful conversation with these people because they have already given forethought to your questions. If you are a Christian and find yourself in the first group, be advised that you share this group with the likes of those who visit the Iawaska camp. All are searching for the Truth. Some have found it. Some have not.
One of the strangest comments I heard that night was of this ‘holy man’, Don Mateo. “This man has brought me closer to Jesus”. “He is a righteous man.” “He is such a holy man; so close to nature”. And that is where they fell apart. They unknowingly voiced a contradiction in terms. They said he was such a “holy” man, so “close to nature”. I don’t think I’m stretching anyone’s words to extrapolate and say that the perfect state would then be where one is perfectly united with nature. But the word ‘holy’ means, in all of its religious significance, to be ‘separate from’. God is Holy because he is holy separate from all that is considered nature. He is not dependent on the laws of nature and is in no way controlled or affected by the laws of nature. He is Holy apart. Don Mateo, on the other hand, was uniting himself with nature and therefore subjecting his life to the laws of nature.
God calls us to by Holy; to be set apart from the laws of the fallen world that rules by the laws of nature. That is the work of sanctification; setting yourself apart from the laws of the natural world and subjecting yourselves to the Holy Spirit. Nature, like human nature, is fallen, and offers no grace.
What these people were saying was that through all their searching and wisdom, they have concluded that they want to find eternal peace and happiness by being fully subjected to the laws of nature. Okay. That’s their decision. But let’s examine the laws of nature. It is generally called the survival of the fittest. Biggest animal wins. The weak die without mercy. If a tree can find enough sun, it grows. It the others find it first, it dies. For the few lost tribes of Indians still roaming through the Amazon, the laws of nature are a fearful reality. It is a day to day battle for survival with the hopes of only being able to die in peace when life is all said and done. It is dark and hopeless. I’m not talking about the appearance of the natural world. It definitely has an awesome beauty that can intoxicate anyone. But if we are talking about the laws of nature, don’t look for grace – you won’t find any.
Christians, like my mystic friends, are searching for the Truth as well. But Christians will seek holiness in a God who is in fact holy separate from the human nature as well as the laws of nature. A Christian can see that all of creation has fallen to the consequence of sin and human nature is no exception. The Laws of God offer forgiveness, grace and freedom like no other religion in the world. I encourage you, if you are a Christian of the 3rd class (those who really don’t know the significance of what they believe), to seek and find the Truths of God. They are rich with meaning and hope; offering grace to even the weakest and ‘brokenest’ of persons.
I love nature and enjoy living close to the elements. God created it and therefore I can stand in awe of Him as I experience it and learn more about it. I’m just glad I’m not subject to its laws.
May God be true to His Word when He offers you the promise that “you will seek Him and find Him when you seek him with all of your heart”. (Jeremiah 29:13)
Saturday, May 14, 2005
Saturday, May 07, 2005
Culture of Crisis
- Third-world culture in the midst of crisis -
The Awakening
Sunday, September 15, 2002
At 30 minutes past mid-night I was slightly aware that Lisa was sitting on the edge of the bed. Not entirely unusual, I didn’t think much about it. Eventually, though, I mustered the strength and consciousness to ask if she was all right. When she whispered a raspy “no”, I immediately shed my slumber. My daily bread for the next 24 hours would be seriously challenged.
She had already been up for twenty minutes with serious pain in her lower abdomen. After looking her over and trying to get my own assessment of the situation, it became very probable to me that she was having what looked like labor pains. The reason I say that is because as any man who has been through child-birth with his wife would know, there is a certain ambience about a women in labor. Her face, body and presence all communicate, “touch me . . . you die!” Lisa also has a certain way she breaths when in labor that you will never otherwise see; A very carefully controlled in-and-out with her eyes squinted shut, cheeks pulled tight and face slightly red. Sound familiar? But Lisa was hardly 7-months pregnant, and these ‘contractions’ acted differently. They didn’t come and go in cycles like normal. They just stayed hard and constant.
As I thought about what to do, the remoteness of our situation suddenly became very real to me. It was midnight in the jungle and I began running through our very few options: Flying to Lima was out since there were no commercial flights to Lima until the next day at noon. Besides that, no airline is going to take a 7-month pregnant woman in labor. Pucallpa, the nearest town, was very limited in medical expertise and not an attractive option. Nevertheless, it was number two on our list of options. The first course of action, then, was to call the Swiss Mission down the road where a number of nurses were located. Maybe there would be a chance we wouldn’t have to go to Pucallpa.
I called Mark Freisen who in turn contacted the on-call nurse at the Swiss base. While I waited for the nurse to arrive, Lisa’s condition grew worse. There was no blood or fluid flowing but the pain was intensifying. A few minutes later a call on the two-meter radio told me that the nurse was on her way and would be another ten minutes before arriving. It was a pitch black, quiet night out at Cashibo, other than the sound of Lisa’s tight controlled breathing. The minutes dragged by horribly slow for Lisa as she tried to find the most pain free position. Lying down only exaggerated the pain while walking was excruciating. She could only sit on the edge of the bed and hold herself up with one arm and try to relax.
What we didn’t know at the time was that her appendix were infected causing labor contractions. The labor contractions, in turn, only augmented her pain from the appendix, which created more labor pains. I felt helpless. I couldn’t do a thing to ease the pain.
Finally at about 1:00 a.m. Alicia, the nurse, arrived with Mark and Urby Friesen. After a brief checkup, it was unanimously decided to take her to the emergency room at the Pucallpa Regional Hospital. Since Lisa didn’t want to be touched or moved, the thought of riding down our severely rutted road for five miles was not real attractive. Once on the highway the condition improved only marginally. Asphalt roads are not a blessing unless they are maintained; and our one-and-only ‘highway’ was in serious disarray with holes causing even the most rugged vehicles to slow to a crawl.
With this vividly in mind, we decided to wake up yet one more family on the SAMAir base - The Schmidts. They unquestionably had the smoothest riding vehicle on base. I called Jon and told him the situation. He was parked in the front yard at the foot of the stairs in five minutes. Moving Lisa from the bedroom to the car necessitated very delicate handling. The pain of this initial move caused her vomiting. We paused near the entryway and Lisa sat on a soft chair while we made final arrangements.
The suddenness of the situation and the pace by which things were happening gave me little time to think about how to prepare for the next few hours, let alone the next two weeks. I tried to put a small bag together of things we might need at the hospital like, tooth brush, p-j’s, toilet paper, . . . etc. Ready for anything. I was patting myself on the back as we were climbing delicately into the back of the vehicle when Lisa leaned over and whispered, “do we have money?” How does she do that? She didn’t ask if I had anything that I did have. Like always, she knew I would probably forget the one thing we would surely need.
You can imagine how the trip from Cashibo to the hospital went. We wanted to hurry but we needed to slow the truck down to a literal crawl to maneuver the ruts and holes. It took us nearly an hour to get to the hospital.
Cultural Collisions - The Emergency Room
My tolerance for cultural difference is inversely proportional to the urgency of the situation. Cultural sensitivity aside, there are right and wrong ways of doing things and my first concern was to get Lisa the best attention possible. Cultural ‘incursions’ or misunderstandings are not on the same scale as losing the life of an unborn child, or your wife. At this point, we still had no certain diagnosis.
When we arrived at the emergency room there were few surprises to shake off since I had been here on several other occasions. Being the middle of the night this time, at least we didn’t have the stuffy mid-day heat to deal with. It was now 2:15 a.m. We were able to send her directly back to see the doctor while I checked in at the front desk. As usual, I was sent across the parking lot to pay the $1.80 fee for use of the emergency room.
When I started to go back where Lisa was they tried to stop me. At this point, there was no way a sleepy-eyed half-wit security boy who likes to assert his only authority ever attained by saying “no pase”, was going to stop me from tending to my wife. I mumbled something in half English and half Spanish, pointed down the hall and kept walking.
I stepped inside the small room where Lisa was and was immediately directed to stand outside by one who appeared to be a doctor. I complied. After standing there for a full ten seconds I could find no logical reason for me to be outside while what looked to me like the janitor and his two best buddies were standing at the foot of Lisa’s bed. I entered again and voiced my opposition. The doctor looked at me, . . . looked at the three amigos and told them to leave. I was able to stay.
The things that were running through our minds varied in their implications. It could be Lisa’s reaction to the baby’s positive blood type. Lisa is A- while I am A+. If the baby has positive blood, then there is a chance that Lisa’s body would reject the new baby as a foreign substance and produce anti-bodies against it [I understand this is not medically correct. I’m a pilot, not a doctor]. We had recently tested for signs of anti-bodies and the results came back negative. Nevertheless, we were recalling the many stories that betrayed the trust of the Pucallpa laboratories. We were advised long ago that Pucallpa is not equipped to handle the situation. In such a case we would have to go to Lima. But this was a very sudden flare up and didn’t seem likely to me.
Or maybe, plain and simple, it was pre-mature labor and the baby was on its way. I couldn’t in my mind accept that. At seven months along, Lisa and I already felt like we knew the baby personally. We could see it move and turn. Every day at the dinner table and bed time Joshua was sure to remind us to pray for our new baby. Not that I didn’t believe it could happen to me but my mind just didn’t accept it.
A few times throughout the night, it was suggested that it might be her appendix. Oddly, it was not the doctors who made the suggestion. Therefore the suggestion was not taken seriously. What are the chances of appendicitis, and what were the consequences? No one ever tested for it.
That night Lisa was tended to by the on-call doctor in the ER as well as Rachel Powell who so graciously came to help out at 2:00 in the morning. Our regular doctor would not be available until later that morning since he wasn’t answering his phone. The other OB-GYN who was on call was able to help. By 2:30 the hard contractions had stopped, leaving Lisa tired and very sore; Not likely to walk home. They admitted her to the hospital and treated her with anti-contraction medication.
Ministry of Health
Things appeared to be at least stable and under control by 3:00 a.m. Lisa was placed in a small room that was occupied by one other woman. The Hospital we were staying in was the Ministry of Health Hospital and as such was the main one in town. The people that worked there were friendly and helpful in the best way they could. They really did their best to make us comfortable, but some of their practices tried my patience and eventually pushed me over the edge. I say that to my shame, not theirs.
The room was a small concrete walled room with light blue tiled floors; dirt in the corners where brooms and mops failed to reach. It had a small bathroom attached with a shower (cold water only). I looked without flinching at the fact that they had neither seat nor lid on the toilet. Toilet paper, of course, would need to be provided by the patient, and I was prepared. The bed was a military green steel-framed bed with a thin but firm mattress over a spring mesh. By the looks of the room both Lisa and I were reminded of the type of equipment you might see on an old ‘MASH’ episode.
Lisa enjoys the luxury of an inclining bed and an oscillating fan. This picture was taken the day before we evacuated her to Lima.Speaking of actual equipment, there was none. No monitors, no test equipment, not even a little button to call the nurse. Matter of fact, in one of the following days, Lisa woke up to find that her I.V. bag had gone dry. With no head pressure stopping it, her blood began to flow in the opposite direction up the I.V. tube and was nearly to the bottle when Lisa noticed. The door was closed and there was no way to get a nurses attention but to holler for help. Thankfully they happened to be near by.
Her I.V bag would hang from a rack three feet above her bed and be controlled manually by timing the drops with a stopwatch. Perfectly adequate, just not the latest technology. Eventually I added the only piece of high-tech equipment to the room when I brought from home a clip-on oscillating fan to keep Lisa from sweating to death. I, meanwhile, sweated to death in the chair next to her bed.
There were windows on one outside wall extending up to the ceiling. However, the only ones that opened were at the very top and as such offered very little circulation of air near the bed. The days we spent in this room were hot, stuffy and dripping with sweat. Outside temperatures during the days were in the 90’s and very humid. Inside temperatures were in the 90’s and unbearably claustrophobic.
At 5:00 a.m. Lisa was revisited by about 15 minutes of contractions that were light to moderate in intensity; just a reminder that things were not yet normal. At 7:30 the contractions came back harder than ever and lasted for two full hours. During this time our usual doctor was able to see her, prescribed stronger anti-contraction medicine, and put her on I.V. His assessment was that she was obviously having labor contractions but was unsure of what was causing them. The main cause for this type of thing in his experience was a urinary infection. He thus started treating her accordingly.
This introduces a little cultural ‘glitch’ that definitely needed to be dealt with. In this culture, the doctors are treating the poorest of the poor. People come in with serious injuries and have to scrape up enough money to afford the $1.60 per night room charge. The medication is not immediately administered because the people rarely can afford it. So the doctors have to make the most probable educated guess and go with it. It is not in their nature to pursue all possible causes in order to insure timely diagnosis. This would be far too expensive for their patients. Why would you waste money on something that might not be the cause because the patient can’t afford to pay for it anyway? The fact that we were ‘rich gringos’ is obvious but does little to change the methodology based on their cultural mindset.
I suggested to the doctor that maybe we should get a blood analysis. Perhaps it’s the Rh factor or maybe even appendicitis. He smirked and shrugged his shoulders and said it wasn’t necessary since these things are “usually caused by a urinary infection”. He told me that we would wait for the results of the urine sample before we made any other conclusions. Impressed by his confidence, I questioned his competence no further.
By 9:30 a.m. the contractions had stopped and Lisa rested for the rest of the morning. At 1:00 p.m. they stopped the I.V. medication and Lisa looked healthy and strong. That is, unless she tried to move. Her lower right abdomen was still very sore to the touch.
The Pharmacy
As mentioned earlier, administration of medication is not assumed. Patients are told what the problem is, handed a prescription, and told to go buy the necessary supplies and medication. If they can afford it, they come back with the proper treatment. If not, the patient waits.
It seemed I was forever being handed these little pieces of paper with an order to buy more medication. These ‘prescriptions’ could be anything from I.V solution, pain killer, cotton bandages, syringes, tubes, or an order for a blood analysis. I would take these slips of paper, walk down the hall, through the emergency room, across the parking lot and under the olive tree to the counter of the pharmacy. There I would tap on the window to wake the pharmacist who would review my request. Didn’t matter how urgent it was, it was always the same routine at the same god forsaken pace. He would then copy the items from my list onto a proper receipt, line by line. When he came to an item that was out of stock, he would simply mark it with an ‘x’ and tell me “No hay”. This meant that I would have to go outside the boundaries of the hospital and shop around at the various pharmacies until I found one that had what I needed. Sometimes this implied a ride all the way down town.
With the prescription properly copied onto a receipt, with a total at the bottom, I would take it around the corner to where the cash box was. You wouldn’t want to put the cash box near the clerk. A light tap on the window would wake the teller and get you a “Cancelado” stamp on your receipt. Correct change would speed up the process immensely.
I would then take this back to the first window under the olive tree and the pharmacist would hopefully have the order together. After exchanging copies of the receipt and double checking quantities he would hand over the supplies. I would walk back across the parking lot being careful to avoid reckless ambulance drivers, step through the throng of people lounging patiently in the stuffy emergency room and make my way back to the nurses’ station. I gave them the medicine and they would administer it in due time - usually. This process I did no less than 17 times; sometimes under higher stress than others.
Hard Decisions
At 7:45 p.m. Lisa began what would be another two-hour episode of hard contractions. We still had no confirmation at to what was causing them. The urine sample came back negative for an infection but for some unknown reason, they never did a blood analysis. First of all, it should have been done the minute she arrived. Then, after the urine analysis came up negative it was an obvious next step in determining if it might be something else, like appendicitis. The doctor was notified and a blood sample was finally ordered. This meant nothing less than a sprint across the parking lot, this time skipping the shade tree and the clerks window, and heading directly to the cash window, paying $3.00, running back, giving the receipt to the right person and making sure it gets followed up.
As I waited for the results of the analysis I began to get very concerned since the probability of appendicitis was getting higher. I had to consider the options quickly since it had already been nearly 20 hours since the definite onset of the symptoms. Do they have the ability to do a clean surgery in Pucallpa on a very pregnant woman? Are they ready if the baby decides to come? The answers were not encouraging. They were absolutely unable to deal with a premature baby at 31 weeks and the likelihood of the operation triggering a birth was higher than I cared to think about. There was no equipment, no training, no experience. Lima was the only place the baby would stand a chance. But what if we tried to get Lisa to Lima and the appendix ruptured? Both the baby and Lisa would be in risk of loosing their lives.
I called Jon and advised him of the situation. I told him we needed to consider evacuating Lisa immediately. I hadn’t made the choice yet but I needed to know my options. Jon called the airlines, the Embassy, and others who might be able to help; anybody who had access to an airplane that could fly to Lima. The only hope came from some very helpful and concerned people at the Embassy. They were going to look into the possibility of getting a plane out that night. I had decided that if we couldn’t get her out by midnight at the latest, she would have to have the surgery there in Pucallpa.
At 10:00 p.m. the results came back and confirmed our suspicion; Appendicitis. The decision about evacuating was removed from my power. It was no longer an option. The Embassy could not get a plane out in time and the doctors said the surgery had to be done within an hour. By this time Lisa was finally feeling some relief from the contractions and I told her the news. I tried to sound positive and confident but I doubt it worked. “Don’t worry,” I said, “There’s not a big risk and the doctors are very good”. When, in fact, the two doctors who were to do the surgery were numbers three and four on our list of preferences since numbers one and two were unavailable. In a setting where medical expertise is rare, this was a big issue; but just one of several things I deliberately failed to tell Lisa until she was out of the hospital.
She went into surgery at 11:05 p.m. Sunday night and was finished two hours and ten minutes later. I found her in the recovery room drugged and very comfortable. Good. She deserved a little comfort after what she went through. She rested for several hours in the recovery room while I went and found her old bed in the maternity ward and caught a couple hours of sleep myself.
September 16-17
The next two days were mild roller coaster rides. Lisa gained her strength very slowly and was still unable to get out of bed. When we asked the doctor when we could leave the hospital he said, “we hope to get her out in four days”. A few minutes later we asked another doctor who was tending Lisa and he said, “most definitely tomorrow”. With this uncertainty we faced each day.
Seeing Lisa with a smile and good health was a welcome sign by all. She was a completely different person. But this character was only present if she didn’t try to get out of bed. At the moment she lifted her head to get up she would get nauseous and week, usually leading to dry heaves. This was a great discouragement for her since walking was a prerequisite to leaving the hospital.
On Tuesday, there were no traces of contractions all day and most of the night. She was now off the anti-contraction IV. Taking her off the IV was like taking one more of the chains that held her to this suffocating cell, and bringing her one step closer to going home. Unfortunately this proved to be a bitter delusion.
Stress Attack
Wednesday, September 18.
After a good night sleep at home I was getting the boys breakfast when Lisa called from the hospital. I had left her my cell phone so we always had communication. I wasn’t planning on going in until later that morning but when she told me she had light contractions again that night, I thought it best to go right away. It was just another one of those sinking feeling you get from going over hills on a roller coaster. When was this thing going to end?
7:30 a.m. I was emotionally and physically drained. I could see the look of fear on Lisa’s face as she considered what the next two hours might be like as the pain continued to intensify. There were tears of fear rolling down her cheeks and I couldn’t do a thing to stop it. I couldn’t stand it. The pain was not at its worse but the thought of it returning was scaring her to death. She didn’t want to have to go through another two hours of hell like she had done several times before. I wasn’t ready to watch her again. It had been three days of this and she wanted it to go away. She wanted to go home to her boys.
I immediately got the attention of the nurses and told them that the contractions were returning and we needed Dr. Mikia right now. “He is coming right away”, they said. I knew enough about the culture to see that they really had no idea when he was coming but that they suspected he would be in at his usual time. I pressed on.
“When will he be here?”
“He’s coming now”, they said; another comment that means nothing in this culture.
“What time”?
Finally they resigned to, “he usually comes in at 8:00”. I went back to check on Lisa and saw that this was not a good prospective. She was no longer on I.V. medication, and the doctor was at least a half hour from even showing up at the hospital. I returned to the nurses’ station and asked if they could contact the doctor since he told me to tell him immediately if the contractions returned. They were returning with full strength and we needed some help immediately. “Can you please call the doctor? He needs to know and Lisa can’t wait. These are contractions!” The fact that this facility was not at all prepared to deal with a premature baby at this stage appeared not to even enter their thinking process.
“We can’t get a hold of the doctor because we don’t have his number. But you may call him.”
I was floored. Not only will these nurses do nothing on their own, they can’t even get a hold of the doctor! “Fine, what’s his number?”
“We have no idea but you could ask at the emergency room. They might have his number there.”
You couldn’t even call the doctor if you wanted to? This was the nurse’s station! I found out later that they didn’t even have an outside line available anywhere near the maternity ward. I bit my tongue and walked away holding my head in disbelief. At this time, I can not actually remember how I found it but I somehow came up with the doctor’s phone number. I called him from my cell phone and told him what was happening. He assured me he was coming “right now”. I was not greatly assured.
I went back to Lisa and tried to assure her anyway that the doctor would be there soon. We waited for what seemed like forever as the contractions grew more intense. They were not the normal type of contractions that gave one a moment of rest between cycles. It was more like one continuous contraction that grew in intensity and slowly died away over a period of two hours. I was feeling helpless and extremely agitated at the passive response of the nurses. After a few minutes, at the risk of insulting the doctor, I gave him another call to ask him what was keeping him. He said he was at the hospital “right now” and that I shouldn’t worry. I hung up the phone and looked up to see him walk around the corner.
Without a moments delay I began, calmly as I could, recounting to him what was going on as if he didn’t get the information from the nurse walking next to him. He examined Lisa for a few minutes, scribbled some notes on a paper and handed it to me. I knew by this time what that meant without explanation - through the ER, across the parking lot, under the tree. . . .etc. etc.
I rushed through my usual obstacle course in record time and arrived at the window under the shade tree. The clerk’s pace was painfully slow and meticulous as usual, exaggerated by the stress of the moment. He glanced at my paper and matter-of-factly put an ‘X’ by the first item. “No hay”. I was beside myself. I did well, however, at keeping my tongue and temper. How on earth can you run a hospital without the supplies you need? The medicine they didn’t have was the anti-contraction medication that Lisa needed right away.
Without purchasing the other medication on the list I grabbed the paper and ventured through the iron gate onto the street to search out a pharmacy that might carry the medicine in stock. A half block down I found a decent looking pharmacy and queried the clerk.
“No hay, senior”. I rushed back into the hospital and asked the Doctor if there was a mistake, or if there was another medicine that he could substitute. He made a couple more notes on the paper and sent me back out to the street. Finally I came up with the medicine - fourteen little boxes that contained glass tubes of anti-contraction medicine to inject into Lisa’s I.V. tube over the next day or so.
When I returned to Lisa’s room the doctor was absent and Lisa’s pain was only getting worse as was indicated, in part, by her heavy breathing, and profuse sweating. I put the medicine on the bed next to Lisa and went to find the nurse so she could administer it to her. “I have the medicine now, can someone give it to her. . . . now?”, I said with as much control as possible. I wanted to scream but managed to subdue my urge by offering a gentle smile here and there. Gotta be charming and polite. The nurse looked at me as if she understood but was not about to do anything about it. I further explained Lisa’s need to have this medicine right away. Her contractions had been going on for an hour now. Still unmoved, I asked where the doctor was.
“He will be here right away”, she said. I couldn’t believe we were playing this game again. Back to Lisa to assure her the medicine was coming and back to the nurses to push for the medicine. This time my voice betrayed my frustration when I demanded that they give her the medicine right away.
“The doctor ordered it, I bought, here it is! Please! She needs this medicine!” I couldn’t believe I actually had to push this hard to make what should have come automatic. What if I wasn’t there?
“The Doctor hasn’t ordered it yet,” they said.
“Yes, he did. Here is his prescription, and the medicine is in the room, “ I explained. No change. They didn’t move. I went back into the room, grabbed one of the little boxes of medicine, and went in search of the doctor. If I was in fact going to demand medicine to be given to Lisa, I at least better confirm that it was the right stuff. I found the doctor tending another patient in the maternity ward and hesitantly interrupted. I realized that Lisa was not the only patient in the hospital but by the looks of my surroundings I concluded that she was, at least for the moment, the most urgent. I showed him the medicine and asked him if it was the right one.
“Yes, of course. Don’t worry”, he said shrugging his shoulders.
“Well then why aren’t they giving it to her?” I asked. “They’re just walking around like they don’t know what to do”. He smiled, as did the other nurses standing around, communicating to me that that was normal. I hurried back to Lisa and somewhere between the Doctor and my arrival outside Lisa’s door, my emotions took over control of my better judgment and patience. I found the nurses still standing and sitting around.
“Did you give her the medicine yet?” I asked.
“No, not yet”.
“Why not?”
“The doctor didn’t write the order down”.
I didn’t know what to say. For lack of Spanish words. For complete disbelief in an archaic system that still existed. For what ever reason. My frustration reached a limit. I looked back at the nurses and realized the futility of my efforts to make an impact, and I broke. I screamed. I echoed down the hall and I cursed. “Dam it!” I slammed the medicine down on the table and glared in disbelief. It was not one of my finer moments. There was nothing I could do while my wife was suffering the consequences of incompetence; both mine and the nurses. I walked back into Lisa’s room and just looked at her. I couldn’t say a thing. I wanted to weep but hadn’t the time. She surely heard my episode in the hallway so trying to assure her that everything was okay was futile. “It’s okay, the doctor is on the way”, I said anyway. But my lack of sleep, emotional roller coaster and cultural ‘adjustments’ had finally pushed me out of my calm and collective presence.
I briefly sat next to Lisa to calm myself at least, if not her. She was doing surprisingly well - trying not to let the stress of the situation distract her from simply trying to relax her body through the contractions. Later on when I asked her about this particular episode she said, “Well, at least you switched back to English”. I had to. We didn’t study those words in language school.
This, at least, got the ball rolling. I’m not sure if the doctor heard me or not but when I checked again in a few minutes, the doctor was there. He indicated to the nurses where he in fact did order the medicine and told them to apply it immediately. Shortly after they gave her the medicine the contractions went away and we were able to joke a little about the situation. I was able to apologize to the nurses, actually being quite impressed at how calm they had been able to remain with me. I figured an apology was a good political move since we would still be under their ‘care’ for a couple more days.
All this had taken place by 9:30 in the morning. It was going to be a long day.
The Game Plan
By Thursday afternoon it had become quite obvious that there was something still wrong with Lisa. Besides the usual residual pain of surgery and contractions, she was still unable to get out of bed without throwing up. Any decrease in anti-contraction medicine meant the return of contractions. Something had to be done. On the way to the hospital in the morning I prayed about the idea of bringing her to Lima at the very first opportunity she was able; even if we needed to order an emergency flight.
I arrived at the hospital and received a call on my cell phone from Rachel Powell who simply wanted to advise me that she felt Lisa should go to Lima as soon as she was able. That was a nice confirmation. A couple hours later Lianes Scharf, a Peruvian friend of ours, stopped by. In the hallway, outside of earshot from Lisa, he confided in me. “Jack, I have to be honest with you. If this was my wife, I would never put her in this hospital. You need to get her out of here”. That was enough confirmation. We would bring her to Lima as soon as we were half able.
That was the plan, but there was still a large obstacle: Lisa couldn’t get up. By this time the doctors concluded that the sickness was due to the fact that there was a slight problem in her spinal column where they did the spinal anesthesia. This could be remedied by doing a ‘blood patch’. Once done, the cure is almost instant; if it works. It is a very common procedure in the states and it simply had to work in order for us to get Lisa out by noon the next day.
By Thursday afternoon we advised the doctors of our plans to get Lisa out the following day, and thus needed the blood patch to be done as soon as possible. Most of the Doctors were compliant to our plans but Dr. Mikia was not ready to let us go and didn’t believe me when I told him we already purchased tickets. He wanted to wait a while and “see what happens”. This was not acceptable in my book since, the way I saw it, there were only two things that could happen: 1. She gets better. 2. She gets worse and the baby is born two months early in a hospital that is not ready for it. I was not about to just wait around and see what happens.
The blood patch was performed at 7:30 Thursday night and took all of 15 minutes. The affect was immediate. She was able to sit up and move her head from side to side without vomiting. Big improvement! But getting out of bed and walking was yet another issue.
The next day we faced only one more obstacle: getting Lisa to the airport and on to the airplane before someone decided she was too ill to fly. The night before Lisa did a “walk” demonstration for Dr. Mikia who was not much impressed. He seriously doubted they would let her on the airplane in her condition. We needed to impress him because if we didn’t, he wouldn’t sign the certificate of good health we needed in order to get on the airplane. The next day Lisa was dressed in her street clothes, looking as ‘normal’ as she could; which wasn’t too difficult as long as she was sitting or lying down.
Some time that morning they pulled the I.V. out of her arm and gave her heavy doses of oral anti-contraction medicine. Even with this she would still have light contractions at times. The doctor signed the certificate and we prepared to leave.
I parked the car as close as possible and we began the first careful steps toward Lima. Pucallpa to Lima is a trip I have made countless times but this time it seemed a world away. There were just too many things that could happen before they actually let us takeoff. What if she looked too weak? What if she started vomiting uncontrollably? What if she went in to hard labor? What if she simply couldn’t walk up the stairs to the airplane?
We made it to the airport in ten minutes. The rough roads, heat and noise were stirring her stomach while the pain never let her get comfortable. It was hot and muggy with plenty of thick dust from the red clay streets.
At the airport we encountered very few problems. I think because we called ahead and told them that we had a medical emergency, they overlooked the fact that Lisa was seven months pregnant. We didn’t volunteer the information about her having sporadic periods of hard labor. We made it to the airplane, throwing up only one time in the corner, unnoticed even by me.
The wheels left the ground and our Pucallpa portion of this adventure was finally finished. It cost us a whole $440 for our five-day stay at the Pucallpa Regional Hospital, including doctor fees and surgery. It cost another $135 for pharmaceutical supplies.
Lima
Friday, September 20
Upon arriving in Lima we both rested for an hour at the SAM Guest house before heading to see Doctor Reategui. The Doctor was hesitant to admit her to the Clinic because he didn’t see any immediate cause for alarm. When I told him how quickly her last two births went he decided it best to watch her for the night. At 7:45 that night Lisa had another hard episode and convinced the doctor he had done the right thing by admitting her into the clinic.
We were extremely impressed with the Doctor and the clinic. We were glad to see toilets with seats, complete with toilet paper. Nurses cared for their patients and took initiative without having to push them. They were so kind. When Lisa had problems, she pressed the button and there they were. More than that, they called the doctor all by themselves. He would arrive immediately no matter what time of day or night. What a change of role for me. I could relax and let them do their job. They immediately took blood samples and cultures to eliminate all possible causes. I didn’t have to ask for a thing. No pushing. No cursing. What a change for me compared to the previous five days. I even had a pull-out bed in the same room. There was room service and prescriptions-on-demand without running to the nearest shade tree pharmacist. No sweltering heat. No constant street noise and dust. It was absolutely beautiful. Neither of us had realized how accustomed we were to the conditions of Pucallpa until we came to Lima. It was as close to the US as we could get in Peru.
Lisa stayed in the Clinica Montesure for five more nights recuperating. She had lost over 13 pounds in six days and looked very thin when she finally left; all this at a time in her pregnancy when she should have been gaining a pound week. After leaving the clinic she stayed at the Lima house for the remainder of her pregnancy. Two months after the initial attack she was finally at the weight she was before it all began on September 15. By the end of her pregnancy she was still within five pounds of her pre-pregnancy weight. The doctor was very concerned that the baby had not gained nearly enough weight.
November 14, 2003.
Justin William Sluiter.
8 lb 9 oz.
On November 14, 2002, we welcomed the birth of a healthy baby boy, Justin William Sluiter. He was born on his due date and was 8 pounds 9 ounces, the heaviest of any of our boys.
You just never know what the next day will bring. Are we ready for the day when we get up in the morning? Are we going to have what it takes to control our temper when things go wrong? Do we have any idea?
Looking back we are so grateful to God that things worked out as well as they did. So many things could have gone wrong and didn’t. So many people jumped in to help with the doctors, take care of kids or provide meals. We have been extremely blessed through the prayers of so many people, most of whom we do not know. What we are finding out now is that, without our knowing, there were groups of people praying for us in Africa, China, Germany, Brazil, Bolivia, Peru, the Netherlands and literally all over the U.S. What a family!
We also recognize our incredible blessings that our lives have already experienced. We, for example, had the opportunity to get Lisa out of Pucallpa and to a quality medical facility. We left a whole hospital full of patients who couldn’t even afford their own medication. They were just pushed out the door when their few pennies ran out and there was no more for the doctors to do. What makes my life more ‘special’ than theirs? The answer is nothing. For some reason that God only knows, He has given us resources and opportunities that are far beyond the reach of 90 % of the people on this planet. All you can say is “Thank you, God”. All you can do is live for Him every day.
Crisis is the battle ground of cultural adaptation. It’s when class-room courtesies are dropped and your instinctive reactions come out. The disappointing thing is that if you have an ugly personality, it will be blaringly obvious in a crisis; all the while if you are patient and kind, it often times goes unnoticed. Such is life. I guess that’s why patience is a virtue to behold, not a trophy to exhibit.
The Awakening
Sunday, September 15, 2002
At 30 minutes past mid-night I was slightly aware that Lisa was sitting on the edge of the bed. Not entirely unusual, I didn’t think much about it. Eventually, though, I mustered the strength and consciousness to ask if she was all right. When she whispered a raspy “no”, I immediately shed my slumber. My daily bread for the next 24 hours would be seriously challenged.
She had already been up for twenty minutes with serious pain in her lower abdomen. After looking her over and trying to get my own assessment of the situation, it became very probable to me that she was having what looked like labor pains. The reason I say that is because as any man who has been through child-birth with his wife would know, there is a certain ambience about a women in labor. Her face, body and presence all communicate, “touch me . . . you die!” Lisa also has a certain way she breaths when in labor that you will never otherwise see; A very carefully controlled in-and-out with her eyes squinted shut, cheeks pulled tight and face slightly red. Sound familiar? But Lisa was hardly 7-months pregnant, and these ‘contractions’ acted differently. They didn’t come and go in cycles like normal. They just stayed hard and constant.
As I thought about what to do, the remoteness of our situation suddenly became very real to me. It was midnight in the jungle and I began running through our very few options: Flying to Lima was out since there were no commercial flights to Lima until the next day at noon. Besides that, no airline is going to take a 7-month pregnant woman in labor. Pucallpa, the nearest town, was very limited in medical expertise and not an attractive option. Nevertheless, it was number two on our list of options. The first course of action, then, was to call the Swiss Mission down the road where a number of nurses were located. Maybe there would be a chance we wouldn’t have to go to Pucallpa.
I called Mark Freisen who in turn contacted the on-call nurse at the Swiss base. While I waited for the nurse to arrive, Lisa’s condition grew worse. There was no blood or fluid flowing but the pain was intensifying. A few minutes later a call on the two-meter radio told me that the nurse was on her way and would be another ten minutes before arriving. It was a pitch black, quiet night out at Cashibo, other than the sound of Lisa’s tight controlled breathing. The minutes dragged by horribly slow for Lisa as she tried to find the most pain free position. Lying down only exaggerated the pain while walking was excruciating. She could only sit on the edge of the bed and hold herself up with one arm and try to relax.
What we didn’t know at the time was that her appendix were infected causing labor contractions. The labor contractions, in turn, only augmented her pain from the appendix, which created more labor pains. I felt helpless. I couldn’t do a thing to ease the pain.
Finally at about 1:00 a.m. Alicia, the nurse, arrived with Mark and Urby Friesen. After a brief checkup, it was unanimously decided to take her to the emergency room at the Pucallpa Regional Hospital. Since Lisa didn’t want to be touched or moved, the thought of riding down our severely rutted road for five miles was not real attractive. Once on the highway the condition improved only marginally. Asphalt roads are not a blessing unless they are maintained; and our one-and-only ‘highway’ was in serious disarray with holes causing even the most rugged vehicles to slow to a crawl.
With this vividly in mind, we decided to wake up yet one more family on the SAMAir base - The Schmidts. They unquestionably had the smoothest riding vehicle on base. I called Jon and told him the situation. He was parked in the front yard at the foot of the stairs in five minutes. Moving Lisa from the bedroom to the car necessitated very delicate handling. The pain of this initial move caused her vomiting. We paused near the entryway and Lisa sat on a soft chair while we made final arrangements.
The suddenness of the situation and the pace by which things were happening gave me little time to think about how to prepare for the next few hours, let alone the next two weeks. I tried to put a small bag together of things we might need at the hospital like, tooth brush, p-j’s, toilet paper, . . . etc. Ready for anything. I was patting myself on the back as we were climbing delicately into the back of the vehicle when Lisa leaned over and whispered, “do we have money?” How does she do that? She didn’t ask if I had anything that I did have. Like always, she knew I would probably forget the one thing we would surely need.
You can imagine how the trip from Cashibo to the hospital went. We wanted to hurry but we needed to slow the truck down to a literal crawl to maneuver the ruts and holes. It took us nearly an hour to get to the hospital.
Cultural Collisions - The Emergency Room
My tolerance for cultural difference is inversely proportional to the urgency of the situation. Cultural sensitivity aside, there are right and wrong ways of doing things and my first concern was to get Lisa the best attention possible. Cultural ‘incursions’ or misunderstandings are not on the same scale as losing the life of an unborn child, or your wife. At this point, we still had no certain diagnosis.
When we arrived at the emergency room there were few surprises to shake off since I had been here on several other occasions. Being the middle of the night this time, at least we didn’t have the stuffy mid-day heat to deal with. It was now 2:15 a.m. We were able to send her directly back to see the doctor while I checked in at the front desk. As usual, I was sent across the parking lot to pay the $1.80 fee for use of the emergency room.
When I started to go back where Lisa was they tried to stop me. At this point, there was no way a sleepy-eyed half-wit security boy who likes to assert his only authority ever attained by saying “no pase”, was going to stop me from tending to my wife. I mumbled something in half English and half Spanish, pointed down the hall and kept walking.
I stepped inside the small room where Lisa was and was immediately directed to stand outside by one who appeared to be a doctor. I complied. After standing there for a full ten seconds I could find no logical reason for me to be outside while what looked to me like the janitor and his two best buddies were standing at the foot of Lisa’s bed. I entered again and voiced my opposition. The doctor looked at me, . . . looked at the three amigos and told them to leave. I was able to stay.
The things that were running through our minds varied in their implications. It could be Lisa’s reaction to the baby’s positive blood type. Lisa is A- while I am A+. If the baby has positive blood, then there is a chance that Lisa’s body would reject the new baby as a foreign substance and produce anti-bodies against it [I understand this is not medically correct. I’m a pilot, not a doctor]. We had recently tested for signs of anti-bodies and the results came back negative. Nevertheless, we were recalling the many stories that betrayed the trust of the Pucallpa laboratories. We were advised long ago that Pucallpa is not equipped to handle the situation. In such a case we would have to go to Lima. But this was a very sudden flare up and didn’t seem likely to me.
Or maybe, plain and simple, it was pre-mature labor and the baby was on its way. I couldn’t in my mind accept that. At seven months along, Lisa and I already felt like we knew the baby personally. We could see it move and turn. Every day at the dinner table and bed time Joshua was sure to remind us to pray for our new baby. Not that I didn’t believe it could happen to me but my mind just didn’t accept it.
A few times throughout the night, it was suggested that it might be her appendix. Oddly, it was not the doctors who made the suggestion. Therefore the suggestion was not taken seriously. What are the chances of appendicitis, and what were the consequences? No one ever tested for it.
That night Lisa was tended to by the on-call doctor in the ER as well as Rachel Powell who so graciously came to help out at 2:00 in the morning. Our regular doctor would not be available until later that morning since he wasn’t answering his phone. The other OB-GYN who was on call was able to help. By 2:30 the hard contractions had stopped, leaving Lisa tired and very sore; Not likely to walk home. They admitted her to the hospital and treated her with anti-contraction medication.
Ministry of Health
Things appeared to be at least stable and under control by 3:00 a.m. Lisa was placed in a small room that was occupied by one other woman. The Hospital we were staying in was the Ministry of Health Hospital and as such was the main one in town. The people that worked there were friendly and helpful in the best way they could. They really did their best to make us comfortable, but some of their practices tried my patience and eventually pushed me over the edge. I say that to my shame, not theirs.
The room was a small concrete walled room with light blue tiled floors; dirt in the corners where brooms and mops failed to reach. It had a small bathroom attached with a shower (cold water only). I looked without flinching at the fact that they had neither seat nor lid on the toilet. Toilet paper, of course, would need to be provided by the patient, and I was prepared. The bed was a military green steel-framed bed with a thin but firm mattress over a spring mesh. By the looks of the room both Lisa and I were reminded of the type of equipment you might see on an old ‘MASH’ episode.
Lisa enjoys the luxury of an inclining bed and an oscillating fan. This picture was taken the day before we evacuated her to Lima.Speaking of actual equipment, there was none. No monitors, no test equipment, not even a little button to call the nurse. Matter of fact, in one of the following days, Lisa woke up to find that her I.V. bag had gone dry. With no head pressure stopping it, her blood began to flow in the opposite direction up the I.V. tube and was nearly to the bottle when Lisa noticed. The door was closed and there was no way to get a nurses attention but to holler for help. Thankfully they happened to be near by.
Her I.V bag would hang from a rack three feet above her bed and be controlled manually by timing the drops with a stopwatch. Perfectly adequate, just not the latest technology. Eventually I added the only piece of high-tech equipment to the room when I brought from home a clip-on oscillating fan to keep Lisa from sweating to death. I, meanwhile, sweated to death in the chair next to her bed.
There were windows on one outside wall extending up to the ceiling. However, the only ones that opened were at the very top and as such offered very little circulation of air near the bed. The days we spent in this room were hot, stuffy and dripping with sweat. Outside temperatures during the days were in the 90’s and very humid. Inside temperatures were in the 90’s and unbearably claustrophobic.
At 5:00 a.m. Lisa was revisited by about 15 minutes of contractions that were light to moderate in intensity; just a reminder that things were not yet normal. At 7:30 the contractions came back harder than ever and lasted for two full hours. During this time our usual doctor was able to see her, prescribed stronger anti-contraction medicine, and put her on I.V. His assessment was that she was obviously having labor contractions but was unsure of what was causing them. The main cause for this type of thing in his experience was a urinary infection. He thus started treating her accordingly.
This introduces a little cultural ‘glitch’ that definitely needed to be dealt with. In this culture, the doctors are treating the poorest of the poor. People come in with serious injuries and have to scrape up enough money to afford the $1.60 per night room charge. The medication is not immediately administered because the people rarely can afford it. So the doctors have to make the most probable educated guess and go with it. It is not in their nature to pursue all possible causes in order to insure timely diagnosis. This would be far too expensive for their patients. Why would you waste money on something that might not be the cause because the patient can’t afford to pay for it anyway? The fact that we were ‘rich gringos’ is obvious but does little to change the methodology based on their cultural mindset.
I suggested to the doctor that maybe we should get a blood analysis. Perhaps it’s the Rh factor or maybe even appendicitis. He smirked and shrugged his shoulders and said it wasn’t necessary since these things are “usually caused by a urinary infection”. He told me that we would wait for the results of the urine sample before we made any other conclusions. Impressed by his confidence, I questioned his competence no further.
By 9:30 a.m. the contractions had stopped and Lisa rested for the rest of the morning. At 1:00 p.m. they stopped the I.V. medication and Lisa looked healthy and strong. That is, unless she tried to move. Her lower right abdomen was still very sore to the touch.
The Pharmacy
As mentioned earlier, administration of medication is not assumed. Patients are told what the problem is, handed a prescription, and told to go buy the necessary supplies and medication. If they can afford it, they come back with the proper treatment. If not, the patient waits.
It seemed I was forever being handed these little pieces of paper with an order to buy more medication. These ‘prescriptions’ could be anything from I.V solution, pain killer, cotton bandages, syringes, tubes, or an order for a blood analysis. I would take these slips of paper, walk down the hall, through the emergency room, across the parking lot and under the olive tree to the counter of the pharmacy. There I would tap on the window to wake the pharmacist who would review my request. Didn’t matter how urgent it was, it was always the same routine at the same god forsaken pace. He would then copy the items from my list onto a proper receipt, line by line. When he came to an item that was out of stock, he would simply mark it with an ‘x’ and tell me “No hay”. This meant that I would have to go outside the boundaries of the hospital and shop around at the various pharmacies until I found one that had what I needed. Sometimes this implied a ride all the way down town.
With the prescription properly copied onto a receipt, with a total at the bottom, I would take it around the corner to where the cash box was. You wouldn’t want to put the cash box near the clerk. A light tap on the window would wake the teller and get you a “Cancelado” stamp on your receipt. Correct change would speed up the process immensely.
I would then take this back to the first window under the olive tree and the pharmacist would hopefully have the order together. After exchanging copies of the receipt and double checking quantities he would hand over the supplies. I would walk back across the parking lot being careful to avoid reckless ambulance drivers, step through the throng of people lounging patiently in the stuffy emergency room and make my way back to the nurses’ station. I gave them the medicine and they would administer it in due time - usually. This process I did no less than 17 times; sometimes under higher stress than others.
Hard Decisions
At 7:45 p.m. Lisa began what would be another two-hour episode of hard contractions. We still had no confirmation at to what was causing them. The urine sample came back negative for an infection but for some unknown reason, they never did a blood analysis. First of all, it should have been done the minute she arrived. Then, after the urine analysis came up negative it was an obvious next step in determining if it might be something else, like appendicitis. The doctor was notified and a blood sample was finally ordered. This meant nothing less than a sprint across the parking lot, this time skipping the shade tree and the clerks window, and heading directly to the cash window, paying $3.00, running back, giving the receipt to the right person and making sure it gets followed up.
As I waited for the results of the analysis I began to get very concerned since the probability of appendicitis was getting higher. I had to consider the options quickly since it had already been nearly 20 hours since the definite onset of the symptoms. Do they have the ability to do a clean surgery in Pucallpa on a very pregnant woman? Are they ready if the baby decides to come? The answers were not encouraging. They were absolutely unable to deal with a premature baby at 31 weeks and the likelihood of the operation triggering a birth was higher than I cared to think about. There was no equipment, no training, no experience. Lima was the only place the baby would stand a chance. But what if we tried to get Lisa to Lima and the appendix ruptured? Both the baby and Lisa would be in risk of loosing their lives.
I called Jon and advised him of the situation. I told him we needed to consider evacuating Lisa immediately. I hadn’t made the choice yet but I needed to know my options. Jon called the airlines, the Embassy, and others who might be able to help; anybody who had access to an airplane that could fly to Lima. The only hope came from some very helpful and concerned people at the Embassy. They were going to look into the possibility of getting a plane out that night. I had decided that if we couldn’t get her out by midnight at the latest, she would have to have the surgery there in Pucallpa.
At 10:00 p.m. the results came back and confirmed our suspicion; Appendicitis. The decision about evacuating was removed from my power. It was no longer an option. The Embassy could not get a plane out in time and the doctors said the surgery had to be done within an hour. By this time Lisa was finally feeling some relief from the contractions and I told her the news. I tried to sound positive and confident but I doubt it worked. “Don’t worry,” I said, “There’s not a big risk and the doctors are very good”. When, in fact, the two doctors who were to do the surgery were numbers three and four on our list of preferences since numbers one and two were unavailable. In a setting where medical expertise is rare, this was a big issue; but just one of several things I deliberately failed to tell Lisa until she was out of the hospital.
She went into surgery at 11:05 p.m. Sunday night and was finished two hours and ten minutes later. I found her in the recovery room drugged and very comfortable. Good. She deserved a little comfort after what she went through. She rested for several hours in the recovery room while I went and found her old bed in the maternity ward and caught a couple hours of sleep myself.
September 16-17
The next two days were mild roller coaster rides. Lisa gained her strength very slowly and was still unable to get out of bed. When we asked the doctor when we could leave the hospital he said, “we hope to get her out in four days”. A few minutes later we asked another doctor who was tending Lisa and he said, “most definitely tomorrow”. With this uncertainty we faced each day.
Seeing Lisa with a smile and good health was a welcome sign by all. She was a completely different person. But this character was only present if she didn’t try to get out of bed. At the moment she lifted her head to get up she would get nauseous and week, usually leading to dry heaves. This was a great discouragement for her since walking was a prerequisite to leaving the hospital.
On Tuesday, there were no traces of contractions all day and most of the night. She was now off the anti-contraction IV. Taking her off the IV was like taking one more of the chains that held her to this suffocating cell, and bringing her one step closer to going home. Unfortunately this proved to be a bitter delusion.
Stress Attack
Wednesday, September 18.
After a good night sleep at home I was getting the boys breakfast when Lisa called from the hospital. I had left her my cell phone so we always had communication. I wasn’t planning on going in until later that morning but when she told me she had light contractions again that night, I thought it best to go right away. It was just another one of those sinking feeling you get from going over hills on a roller coaster. When was this thing going to end?
7:30 a.m. I was emotionally and physically drained. I could see the look of fear on Lisa’s face as she considered what the next two hours might be like as the pain continued to intensify. There were tears of fear rolling down her cheeks and I couldn’t do a thing to stop it. I couldn’t stand it. The pain was not at its worse but the thought of it returning was scaring her to death. She didn’t want to have to go through another two hours of hell like she had done several times before. I wasn’t ready to watch her again. It had been three days of this and she wanted it to go away. She wanted to go home to her boys.
I immediately got the attention of the nurses and told them that the contractions were returning and we needed Dr. Mikia right now. “He is coming right away”, they said. I knew enough about the culture to see that they really had no idea when he was coming but that they suspected he would be in at his usual time. I pressed on.
“When will he be here?”
“He’s coming now”, they said; another comment that means nothing in this culture.
“What time”?
Finally they resigned to, “he usually comes in at 8:00”. I went back to check on Lisa and saw that this was not a good prospective. She was no longer on I.V. medication, and the doctor was at least a half hour from even showing up at the hospital. I returned to the nurses’ station and asked if they could contact the doctor since he told me to tell him immediately if the contractions returned. They were returning with full strength and we needed some help immediately. “Can you please call the doctor? He needs to know and Lisa can’t wait. These are contractions!” The fact that this facility was not at all prepared to deal with a premature baby at this stage appeared not to even enter their thinking process.
“We can’t get a hold of the doctor because we don’t have his number. But you may call him.”
I was floored. Not only will these nurses do nothing on their own, they can’t even get a hold of the doctor! “Fine, what’s his number?”
“We have no idea but you could ask at the emergency room. They might have his number there.”
You couldn’t even call the doctor if you wanted to? This was the nurse’s station! I found out later that they didn’t even have an outside line available anywhere near the maternity ward. I bit my tongue and walked away holding my head in disbelief. At this time, I can not actually remember how I found it but I somehow came up with the doctor’s phone number. I called him from my cell phone and told him what was happening. He assured me he was coming “right now”. I was not greatly assured.
I went back to Lisa and tried to assure her anyway that the doctor would be there soon. We waited for what seemed like forever as the contractions grew more intense. They were not the normal type of contractions that gave one a moment of rest between cycles. It was more like one continuous contraction that grew in intensity and slowly died away over a period of two hours. I was feeling helpless and extremely agitated at the passive response of the nurses. After a few minutes, at the risk of insulting the doctor, I gave him another call to ask him what was keeping him. He said he was at the hospital “right now” and that I shouldn’t worry. I hung up the phone and looked up to see him walk around the corner.
Without a moments delay I began, calmly as I could, recounting to him what was going on as if he didn’t get the information from the nurse walking next to him. He examined Lisa for a few minutes, scribbled some notes on a paper and handed it to me. I knew by this time what that meant without explanation - through the ER, across the parking lot, under the tree. . . .etc. etc.
I rushed through my usual obstacle course in record time and arrived at the window under the shade tree. The clerk’s pace was painfully slow and meticulous as usual, exaggerated by the stress of the moment. He glanced at my paper and matter-of-factly put an ‘X’ by the first item. “No hay”. I was beside myself. I did well, however, at keeping my tongue and temper. How on earth can you run a hospital without the supplies you need? The medicine they didn’t have was the anti-contraction medication that Lisa needed right away.
Without purchasing the other medication on the list I grabbed the paper and ventured through the iron gate onto the street to search out a pharmacy that might carry the medicine in stock. A half block down I found a decent looking pharmacy and queried the clerk.
“No hay, senior”. I rushed back into the hospital and asked the Doctor if there was a mistake, or if there was another medicine that he could substitute. He made a couple more notes on the paper and sent me back out to the street. Finally I came up with the medicine - fourteen little boxes that contained glass tubes of anti-contraction medicine to inject into Lisa’s I.V. tube over the next day or so.
When I returned to Lisa’s room the doctor was absent and Lisa’s pain was only getting worse as was indicated, in part, by her heavy breathing, and profuse sweating. I put the medicine on the bed next to Lisa and went to find the nurse so she could administer it to her. “I have the medicine now, can someone give it to her. . . . now?”, I said with as much control as possible. I wanted to scream but managed to subdue my urge by offering a gentle smile here and there. Gotta be charming and polite. The nurse looked at me as if she understood but was not about to do anything about it. I further explained Lisa’s need to have this medicine right away. Her contractions had been going on for an hour now. Still unmoved, I asked where the doctor was.
“He will be here right away”, she said. I couldn’t believe we were playing this game again. Back to Lisa to assure her the medicine was coming and back to the nurses to push for the medicine. This time my voice betrayed my frustration when I demanded that they give her the medicine right away.
“The doctor ordered it, I bought, here it is! Please! She needs this medicine!” I couldn’t believe I actually had to push this hard to make what should have come automatic. What if I wasn’t there?
“The Doctor hasn’t ordered it yet,” they said.
“Yes, he did. Here is his prescription, and the medicine is in the room, “ I explained. No change. They didn’t move. I went back into the room, grabbed one of the little boxes of medicine, and went in search of the doctor. If I was in fact going to demand medicine to be given to Lisa, I at least better confirm that it was the right stuff. I found the doctor tending another patient in the maternity ward and hesitantly interrupted. I realized that Lisa was not the only patient in the hospital but by the looks of my surroundings I concluded that she was, at least for the moment, the most urgent. I showed him the medicine and asked him if it was the right one.
“Yes, of course. Don’t worry”, he said shrugging his shoulders.
“Well then why aren’t they giving it to her?” I asked. “They’re just walking around like they don’t know what to do”. He smiled, as did the other nurses standing around, communicating to me that that was normal. I hurried back to Lisa and somewhere between the Doctor and my arrival outside Lisa’s door, my emotions took over control of my better judgment and patience. I found the nurses still standing and sitting around.
“Did you give her the medicine yet?” I asked.
“No, not yet”.
“Why not?”
“The doctor didn’t write the order down”.
I didn’t know what to say. For lack of Spanish words. For complete disbelief in an archaic system that still existed. For what ever reason. My frustration reached a limit. I looked back at the nurses and realized the futility of my efforts to make an impact, and I broke. I screamed. I echoed down the hall and I cursed. “Dam it!” I slammed the medicine down on the table and glared in disbelief. It was not one of my finer moments. There was nothing I could do while my wife was suffering the consequences of incompetence; both mine and the nurses. I walked back into Lisa’s room and just looked at her. I couldn’t say a thing. I wanted to weep but hadn’t the time. She surely heard my episode in the hallway so trying to assure her that everything was okay was futile. “It’s okay, the doctor is on the way”, I said anyway. But my lack of sleep, emotional roller coaster and cultural ‘adjustments’ had finally pushed me out of my calm and collective presence.
I briefly sat next to Lisa to calm myself at least, if not her. She was doing surprisingly well - trying not to let the stress of the situation distract her from simply trying to relax her body through the contractions. Later on when I asked her about this particular episode she said, “Well, at least you switched back to English”. I had to. We didn’t study those words in language school.
This, at least, got the ball rolling. I’m not sure if the doctor heard me or not but when I checked again in a few minutes, the doctor was there. He indicated to the nurses where he in fact did order the medicine and told them to apply it immediately. Shortly after they gave her the medicine the contractions went away and we were able to joke a little about the situation. I was able to apologize to the nurses, actually being quite impressed at how calm they had been able to remain with me. I figured an apology was a good political move since we would still be under their ‘care’ for a couple more days.
All this had taken place by 9:30 in the morning. It was going to be a long day.
The Game Plan
By Thursday afternoon it had become quite obvious that there was something still wrong with Lisa. Besides the usual residual pain of surgery and contractions, she was still unable to get out of bed without throwing up. Any decrease in anti-contraction medicine meant the return of contractions. Something had to be done. On the way to the hospital in the morning I prayed about the idea of bringing her to Lima at the very first opportunity she was able; even if we needed to order an emergency flight.
I arrived at the hospital and received a call on my cell phone from Rachel Powell who simply wanted to advise me that she felt Lisa should go to Lima as soon as she was able. That was a nice confirmation. A couple hours later Lianes Scharf, a Peruvian friend of ours, stopped by. In the hallway, outside of earshot from Lisa, he confided in me. “Jack, I have to be honest with you. If this was my wife, I would never put her in this hospital. You need to get her out of here”. That was enough confirmation. We would bring her to Lima as soon as we were half able.
That was the plan, but there was still a large obstacle: Lisa couldn’t get up. By this time the doctors concluded that the sickness was due to the fact that there was a slight problem in her spinal column where they did the spinal anesthesia. This could be remedied by doing a ‘blood patch’. Once done, the cure is almost instant; if it works. It is a very common procedure in the states and it simply had to work in order for us to get Lisa out by noon the next day.
By Thursday afternoon we advised the doctors of our plans to get Lisa out the following day, and thus needed the blood patch to be done as soon as possible. Most of the Doctors were compliant to our plans but Dr. Mikia was not ready to let us go and didn’t believe me when I told him we already purchased tickets. He wanted to wait a while and “see what happens”. This was not acceptable in my book since, the way I saw it, there were only two things that could happen: 1. She gets better. 2. She gets worse and the baby is born two months early in a hospital that is not ready for it. I was not about to just wait around and see what happens.
The blood patch was performed at 7:30 Thursday night and took all of 15 minutes. The affect was immediate. She was able to sit up and move her head from side to side without vomiting. Big improvement! But getting out of bed and walking was yet another issue.
The next day we faced only one more obstacle: getting Lisa to the airport and on to the airplane before someone decided she was too ill to fly. The night before Lisa did a “walk” demonstration for Dr. Mikia who was not much impressed. He seriously doubted they would let her on the airplane in her condition. We needed to impress him because if we didn’t, he wouldn’t sign the certificate of good health we needed in order to get on the airplane. The next day Lisa was dressed in her street clothes, looking as ‘normal’ as she could; which wasn’t too difficult as long as she was sitting or lying down.
Some time that morning they pulled the I.V. out of her arm and gave her heavy doses of oral anti-contraction medicine. Even with this she would still have light contractions at times. The doctor signed the certificate and we prepared to leave.
I parked the car as close as possible and we began the first careful steps toward Lima. Pucallpa to Lima is a trip I have made countless times but this time it seemed a world away. There were just too many things that could happen before they actually let us takeoff. What if she looked too weak? What if she started vomiting uncontrollably? What if she went in to hard labor? What if she simply couldn’t walk up the stairs to the airplane?
We made it to the airport in ten minutes. The rough roads, heat and noise were stirring her stomach while the pain never let her get comfortable. It was hot and muggy with plenty of thick dust from the red clay streets.
At the airport we encountered very few problems. I think because we called ahead and told them that we had a medical emergency, they overlooked the fact that Lisa was seven months pregnant. We didn’t volunteer the information about her having sporadic periods of hard labor. We made it to the airplane, throwing up only one time in the corner, unnoticed even by me.
The wheels left the ground and our Pucallpa portion of this adventure was finally finished. It cost us a whole $440 for our five-day stay at the Pucallpa Regional Hospital, including doctor fees and surgery. It cost another $135 for pharmaceutical supplies.
Lima
Friday, September 20
Upon arriving in Lima we both rested for an hour at the SAM Guest house before heading to see Doctor Reategui. The Doctor was hesitant to admit her to the Clinic because he didn’t see any immediate cause for alarm. When I told him how quickly her last two births went he decided it best to watch her for the night. At 7:45 that night Lisa had another hard episode and convinced the doctor he had done the right thing by admitting her into the clinic.
We were extremely impressed with the Doctor and the clinic. We were glad to see toilets with seats, complete with toilet paper. Nurses cared for their patients and took initiative without having to push them. They were so kind. When Lisa had problems, she pressed the button and there they were. More than that, they called the doctor all by themselves. He would arrive immediately no matter what time of day or night. What a change of role for me. I could relax and let them do their job. They immediately took blood samples and cultures to eliminate all possible causes. I didn’t have to ask for a thing. No pushing. No cursing. What a change for me compared to the previous five days. I even had a pull-out bed in the same room. There was room service and prescriptions-on-demand without running to the nearest shade tree pharmacist. No sweltering heat. No constant street noise and dust. It was absolutely beautiful. Neither of us had realized how accustomed we were to the conditions of Pucallpa until we came to Lima. It was as close to the US as we could get in Peru.
Lisa stayed in the Clinica Montesure for five more nights recuperating. She had lost over 13 pounds in six days and looked very thin when she finally left; all this at a time in her pregnancy when she should have been gaining a pound week. After leaving the clinic she stayed at the Lima house for the remainder of her pregnancy. Two months after the initial attack she was finally at the weight she was before it all began on September 15. By the end of her pregnancy she was still within five pounds of her pre-pregnancy weight. The doctor was very concerned that the baby had not gained nearly enough weight.
November 14, 2003.
Justin William Sluiter.
8 lb 9 oz.
On November 14, 2002, we welcomed the birth of a healthy baby boy, Justin William Sluiter. He was born on his due date and was 8 pounds 9 ounces, the heaviest of any of our boys.
You just never know what the next day will bring. Are we ready for the day when we get up in the morning? Are we going to have what it takes to control our temper when things go wrong? Do we have any idea?
Looking back we are so grateful to God that things worked out as well as they did. So many things could have gone wrong and didn’t. So many people jumped in to help with the doctors, take care of kids or provide meals. We have been extremely blessed through the prayers of so many people, most of whom we do not know. What we are finding out now is that, without our knowing, there were groups of people praying for us in Africa, China, Germany, Brazil, Bolivia, Peru, the Netherlands and literally all over the U.S. What a family!
We also recognize our incredible blessings that our lives have already experienced. We, for example, had the opportunity to get Lisa out of Pucallpa and to a quality medical facility. We left a whole hospital full of patients who couldn’t even afford their own medication. They were just pushed out the door when their few pennies ran out and there was no more for the doctors to do. What makes my life more ‘special’ than theirs? The answer is nothing. For some reason that God only knows, He has given us resources and opportunities that are far beyond the reach of 90 % of the people on this planet. All you can say is “Thank you, God”. All you can do is live for Him every day.
Crisis is the battle ground of cultural adaptation. It’s when class-room courtesies are dropped and your instinctive reactions come out. The disappointing thing is that if you have an ugly personality, it will be blaringly obvious in a crisis; all the while if you are patient and kind, it often times goes unnoticed. Such is life. I guess that’s why patience is a virtue to behold, not a trophy to exhibit.
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